Rotator Cuff Surgery - Now an Outpatient Procedure

January 25, 2005

By: Steve Siwy for Shoulder1.com

When Senator John Kerry had rotator cuff surgery, he was in and out of the hospital in a matter of a few hours. That short stay is quite an improvement over the past, when such a surgery would keep a patient in the hospital for days. Innovations in pain control and less invasive techniques mean that rotator cuff surgery can now be performed on an outpatient basis.

The rotator cuff is a collection of four muscles enveloping the ball at the top of the humerus (upper armbone). They rotate and elevate the arm, and stabilize it in the shoulder joint. According to the American Academy of Orthopaedic Surgeons (AAOS), the muscle most often involved in rotator cuff tears is the supraspinatus (the other three are the infraspinatus, the teres minor, and the subcapularis).

Acute injuries respond best to surgery, and are the most likely to be treated by surgical procedure without first having the patient attempt a trial of more conservative treatments. Athletes, especially baseball pitchers (who spend much of their time performing the overhand motion that commonly leads to rotator cuff injury), and people who work at strenuous jobs such as construction, are most at risk for an acute injury. Acute injuries can also be caused by sudden trauma, such as when Senator Kerry braced himself with an outstretched hand as his campaign bus stopped short.

Conservative treatments, usually the first line of defense for patients with any orthopaedic condition, are especially preferred by doctors in cases of torn rotator cuffs, according to the AAOS, because there is no evidence that early surgical intervention has better results than surgery performed after a delay. Conservative treatment can include non-steroidal anti-inflammatory drugs (NSAID’s), such as ibuprofen or acetaminophen The patient will usually also be instructed to avoid activities that cause symptoms to flare up. If conservative treatment fails to alleviate shoulder pain, or if the tear is too large or too debilitating to approach conservatively, surgery may then be called for in these cases as well.

Rotator cuff surgery can be performed either arthroscopically, using pencil-thin cameras and tools inserted through narrow incisions, or using a more traditional open-shoulder method. Either technique, though, can now be done as an outpatient procedure. The Mayo Clinic, for instance, uses a regional anesthesia around the surgery site, coupled with a pain-control IV to deliver analgesic medication as necessary (rotator cuff surgery, though now simplified, can still be very painful). Thus, patients at the clinic are usually able to go home on the same day they have surgery.

The recovery period is similar for both kinds of rotator cuff surgery, as well. Again, to use the Mayo Clinic as an example, patients of both arthroscopic and open-shoulder outpatient rotator cuff surgery typically keep their arms in a sling for four to six weeks, while participating in gentle exercises to maintain a range of motion in the arm. After the arm is out of the sling, formal physical therapy begins, which then goes on for two to three months, with patients being able to return to recreation like golf an tennis after about four of five months (though it may take up to a year for full strength to return).

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